Paxil vs Remeron

Listen to the article instead of reading through it.


For patients suffering from major depressive disorder (MDD) or other types of depression, certain medications that modify the levels of brain chemicals associated with mood—known as neurotransmitters—can aid in stabilizing depressive lows and managing symptoms. Paxil and Remeron are two such drugs frequently prescribed for depression. Each affects different neurotransmitters in the brain but both have shown to stabilize mood in patients with depression. Paxil is classified as a selective serotonin reuptake inhibitor (SSRI), influencing levels of serotonin—a neurotransmitter linked to happiness and well-being. On the other hand, Remeron falls under the class of atypical antidepressants which work by blocking specific adrenergic receptors thus increasing levels of norepinephrine along with serotonin and dopamine.

What is Paxil?

Paroxetine (the generic name for Paxil) is a selective serotonin reuptake inhibitor (SSRI), which marked an improvement in the class of antidepressant medications. Paroxetine was first approved by the FDA in 1992. Similar to Prozac, Paxil also increases levels of free serotonin by preventing its reabsorption effectively, making it available in the brain longer than usual. It is prescribed primarily for depression and anxiety disorders.

On the other hand, Mirtazapine (the generic name for Remeron) belongs to a different class of antidepressants known as tetracyclic antidepressants. Unlike SSRIs like Paxil, Remeron does not prevent serotonin's reabsorption but instead increases its release into the system along with another neurotransmitter called norepinephrine.

Paxil selectively influences serotonin with only minor influence on dopamine and norepinephrine, resulting in fewer side effects compared to other antidepressants that have stronger effects on these two other neurotransmitters. Compared to Remeron, which may cause weight gain or increased appetite due to its dual action on both serotonin and norepinephrine.

What conditions is Paxil approved to treat?

Paxil is approved for the treatment of several mental health conditions:

  • Major depressive disorder (MDD)
  • Obsessive-compulsive disorder (OCD)
  • Panic disorder
  • Social anxiety disorder
  • Generalized anxiety disorder
  • Posttraumatic stress disorder (PTSD)

How does Paxil help with these illnesses?

Paxil, like Prozac, is a selective serotonin reuptake inhibitor (SSRI) that helps manage depression by increasing the amount of serotonin available in the synapses of the brain. It does this by blocking its reabsorption into neurons so levels can be maintained higher for longer periods of time. On the other hand, Remeron works differently; it's an alpha-2 antagonist which boosts norepinephrine and serotonin production but also blocks certain types of serotonin receptors to balance mood regulation effects. This function makes Remeron particularly useful in treating anxiety-related depression or depression with significant sleep disturbances since it has sedative properties as well. Both medications target neurotransmitters in order to alleviate symptoms of depression and stabilize mood, although their mechanisms differ slightly which may make one more suitable than the other depending on individual patient needs.

What is Remeron?

Remeron, also known as mirtazapine, is a noradrenergic and specific serotonergic antidepressant (NaSSA), which means it increases the levels of norepinephrine (also called noradrenaline) and serotonin in the brain by reducing their reabsorption. It also blocks histamine receptors, meaning it has an effect on another neurotransmitter, histamine. Remeron was first approved by the FDA in 1996. Unlike Paxil which is a selective serotonin reuptake inhibitor (SSRI), Remeron does not solely focus on inhibiting the reuptake of serotonin but also works with norepinephrine. This difference in action means that its side-effect profile can differ from that of SSRIs like Paxil - for example, while weight gain can be a common side effect with both medications due to increased appetite, sedation tends to be more pronounced with Remeron due to its antihistaminic properties. The effects on both norepinephrine and specific types of serotonin receptors can make it beneficial for treating depression especially in patients who do not respond well to "typical" SSRI drugs such as Paxil.

What conditions is Remeron approved to treat?

Remeron, known scientifically as mirtazapine, has been approved for the treatment of:

  • Major depressive disorder (MDD), which is often characterized by persistent feelings of sadness and a lack of interest or pleasure in previously enjoyed activities.
  • Sleep disorders due to its sedative properties, it can be beneficial for those who have trouble sleeping.

How does Remeron help with these illnesses?

Norepinephrine is a neurotransmitter that also acts as a hormone, playing roles in many bodily processes such as wakefulness, memory recall, focus and attention. It's heavily involved in the "fight or flight" response to prepare the body for actions under stress. Similar to serotonin, low levels of norepinephrine have been implicated in depression. Remeron works by increasing the levels of both norepinephrine and serotonin available in the brain; this dual action can help alleviate some symptoms of depression more effectively than selective serotonin reuptake inhibitors (SSRIs) like Paxil which primarily affect serotonin levels only. Additionally, Remeron has an antihistamine effect leading to its sedative properties, making it particularly beneficial for patients with sleep disturbances associated with their depressive disorders. Therefore, it may be prescribed when a patient does not respond well to typical SSRIs or may even be combined with them.

How effective are both Paxil and Remeron?

Both paroxetine (Paxil) and mirtazapine (Remeron) have proven to be effective in treating major depressive disorder, with initial approval from the FDA coming only 3 years apart. They act on different neurotransmitters, therefore they may be administered under varying circumstances. The effectiveness of paroxetine and mirtazapine in alleviating depression was directly compared in a double-blind clinical trial conducted in 2001; both drugs exhibited similar efficacy when it comes to managing symptoms of depression and displayed promising safety profiles. In this study, there were no significant differences between measures used to evaluate the efficiency of treatment for depressive symptoms among patients receiving either paroxetine or mirtazapine.

A meta-analysis report published in 2002 demonstrated that paroxetine is effective at relieving symptoms of depression starting from the first week of treatment, has a side effect profile comparable to many other antidepressants, and is generally well-tolerated across diverse populations including elderly individuals. As an SSRI-class drug with a substantial history dating back several decades, Paxil's performance as an antidepressant has been thoroughly documented - its optimal dosage for therapeutic efficacy is considered to be around 20 mg/day.

On the other hand, a review and meta-analysis conducted in 2018 suggested that mirtazapine seems more potent than placebo as an antidepressant therapy option but exhibits similar effectiveness levels compared to most common antidepressants. Though typically positioned as second-line treatment option after SSRIs like Paxil fail or deliver inadequate results due to adverse side effects such as sexual dysfunction or weight gain issues - which can potentially be avoided by using Remeron instead.

abstract image of a researcher studying a bottle of drug.

At what dose is Paxil typically prescribed?

Oral dosages of Paxil range from 20–50 mg/day, but research has shown that 20 mg/day is sufficient for treating major depressive disorder in most people. Adolescents may be started on a lower dose of 10 mg/day. In any case, dosage can be increased after a few weeks if there is no response. The maximum dosage that should not be exceeded under any circumstance is 60 mg/day.

On the other hand, Remeron is typically given at an initial oral dose of 15 mg per day and it's usually taken before bedtime due to its sedative effect. This can later be adjusted by your physician depending on your body’s response to treatment with increments up to about a maximum of 45mg per day.

Find Top Clinical Trials

Choose from over 30,000 active clinical trials.

At what dose is Remeron typically prescribed?

Remeron therapy typically begins with a dosage of 15 mg/day, taken before bedtime. Depending on the patient's response and tolerance to treatment, the dose can then be increased to 30 mg/day, also taken before bedtime. The maximum daily recommended dose is 45 mg, which may be considered if there's no positive response after several weeks at lower doses. This maximum dose should ideally be divided into two intakes: one in the evening and another smaller intake during the day based on your doctor's instructions.

What are the most common side effects for Paxil?

Some of the common side effects that may be experienced when taking Paxil and Remeron include:

  • Anxiety or nervousness
  • Trouble sleeping (insomnia) or excessive sleepiness (somnolence)
  • General weakness and fatigue (asthenia)
  • Shaking, often due to muscle weakness or nervousness (tremor)
  • Loss of appetite (anorexia), nausea, and digestive discomfort (dyspepsia)
  • Diarrhea
  • Dry mouth
  • Changes in sexual desire or ability, including decreased libido, abnormal ejaculation, and impotence
  • Skin reactions such as rash
  • Sweating more than usual
  • Unusual dreams -Dry mouth
    -Symptoms similar to flu syndrome -Throat inflammation causing a sore throat(pharyngitis) -Inflammation of sinus cavities leading to symptoms like headache, pain around cheeks & eyes(sinusitis).

Always remember that although these are potential side effects of both medications they do not occur in all individuals. If any new symptoms arise during treatment with either drug it is important to consult with your healthcare provider promptly.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Paxil?

While both Paxil and Remeron are used to treat depression, they can have different side effects. Here are some of the potential serious side effects associated with Paxil:

  • Increased thoughts about suicide or self-harm, especially in children and young adults
  • Signs of allergic reaction: hives, difficult breathing, swelling in your face or throat
  • Changes in vision such as blurred vision, tunnel vision or seeing halos around lights
  • Heart problems: fast heartbeats, chest pain or discomfort; lightheadedness like you might pass out
  • Low sodium levels: headache, confusion, slurred speech severe weakness vomiting loss of coordination feeling unsteady
  • Severe nervous system reactions - very stiff (rigid) muscles high fever sweating confusion fast uneven heartbeats tremors feeling like you might pass out.

In contrast here are some potentially serious Remeron side effects:

  • An increase in suicidal thoughts particularly for people under 25 years old.
  • Allergic reaction signs such as skin rash itching/hives red itchy welts fever trouble breathing tightness in the chest or throat difficulty talking unusual hoarseness swelling of the mouth face lips tongue throat hands legs feet ankles eyes
  • Eye pain changes in vision swelling/redness -Seizures a rapid heartbeat fainting -Low sodium levels nausea weak tired feeling confusion memory problems hallucinations falling seizures headaches not wanting to eat focusing issues more saliva/seizures shakiness/spasms that are new/worse restlessness racing heartbeat high/low blood pressure throwing up significant weight gain/loss

Always consult a healthcare professional before starting any medication regimen.

What are the most common side effects for Remeron?

Remeron, like many other medications, can come with its share of potential side effects. Some individuals may experience:

  • Dry mouth or increased salivation
  • An increase in appetite which may lead to weight gain
  • Drowsiness or fatigue
  • Constipation
  • Occasional dizziness
  • A feeling of restlessness and agitation.

It's also worth noting that while much less common, some users have reported experiencing muscle pain or joint aches as well. Always remember that each person's body reacts differently to medication; what one person experiences isn't necessarily the norm for everyone else. Contact your healthcare professional if you encounter any severe or persistent side effects.

Are there any potential serious side effects for Remeron?

Remeron, like any other medication, can cause side effects. Though most of these are mild and tolerable, some may be serious and require immediate medical attention. These include:

  • Signs of an allergic reaction such as hives; difficulty breathing; swelling of your face, lips, tongue or throat
  • Unusual changes in mood or behavior
  • Increased suicidal thoughts or feelings
  • Confusion or memory problems
  • A sudden severe headache or problems with vision, speech or balance (signs of a stroke)
  • Palpitations (fast heartbeats), chest pain
  • Sudden weakness on one side of the body (indicative of neurological issues)
  • Blurred vision

If you experience any such adverse symptoms after taking Remeron, it is crucial to seek immediate medical help.

Contraindications for Paxil and Remeron?

Just like Wellbutrin and Prozac, Paxil and Remeron, as well as most other antidepressant medications may exacerbate symptoms of depression in some individuals. If you observe an intensification in your depressive feelings or a surge in suicidal ideation, thoughts or behaviors while taking either drug, it's crucial that you seek immediate medical attention.

Both Paxil and Remeron are contraindicated if you are currently taking or have recently stopped using monoamine oxidase (MAO) inhibitors. Always be clear with your healthcare provider about any current medication you're on; MAOIs will necessitate approximately 5 weeks to completely leave your system before initiating treatment with either Paxil or Remeron to avoid dangerous interactions.

How much do Paxil and Remeron cost?

For the brand name versions of these drugs:

  • The price of 30 tablets of Paxil (20 mg) averages around $290, or between $9-$19/day depending on your dose.
  • In comparison, a monthly supply of Remeron (30 mg), approximately costs $140, working out to roughly $4.5/day.

Thus, if you are in the higher dosage range for Paxil (i.e., 40 mg/day or higher), then brand-name Remeron is less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.

As for their generic versions:

  • Paroxetine (the generic version of Paxil) comes in packs ranging from 10 to 500 tablets with an approximate cost starting as low as about $0.21/day and generally not exceeding about $1.50/day.
  • Mirtazapine (generic Remeron) can also be obtained at lower prices than its branded counterpart - typically costing between $0.10 and $2 per day depending on the pack size and daily dosage requirements.

Remember that while generics are usually cheaper than their branded counterparts, effectiveness may vary based on individual factors so it's important to discuss this with your healthcare provider prior deciding what's best for you.

Popularity of Paxil and Remeron

Paroxetine, also known by its brand name Paxil, was prescribed to approximately 3.5 million Americans in 2020. Accounting for nearly 8% of all SSRI prescriptions and around 4% of total antidepressant prescriptions in the US. The use of paroxetine has been relatively steady over the past decade.

Mirtazapine, often referred to as Remeron, had about 2.7 million prescriptions filled in the U.S during 2020. Mirtazapine is classified as a tetracyclic antidepressant (TeCA) which makes it less common than SSRIs such as Paroxetine but still widely used due to its unique mechanisms that can be beneficial for certain patients, especially those with sleep disorders or significant anxiety associated with their depression. Usage patterns indicate mirtazapine usage has seen an increase since around mid-2010s.


Both Paxil (paroxetine) and Remeron (mirtazapine) have a long history of use in treating depression, with numerous clinical studies and meta-analyses backing their effectiveness over placebo treatments. In some cases, these drugs may be used together, but this requires careful consideration by a physician due to potential interactions. Their mechanisms of action differ; Paxil primarily acts on serotonin while Remeron acts on both serotonin and norepinephrine receptors.

Paxil is typically considered a first-line treatment for depression and anxiety disorders, whereas Remeron is often used when patients don't respond well to SSRIs like Paxil, or it might be added as an adjunct therapy to enhance the effects of initial antidepressant treatment. Notably, Remeron can also help manage symptoms such as poor sleep and loss of appetite that are common in depression.

Both medications are available in generic form which represents substantial cost savings especially for patients paying out-of-pocket. Both Paxil and Remeron may require an adjustment period before noticeable effects occur.

The side effect profiles are somewhat similar between the two drugs: they're generally well-tolerated but do carry risks. These include sexual dysfunction more commonly seen with Paxil usage and weight gain more associated with Remeron. Patients must closely monitor their moods when starting either medication - if you notice worsening depression or start having suicidal thoughts or thoughts about self-harm seek immediate medical attention.